APPROACH TO CSA ASSESSMENT & FEEDBACK

RCGP has clearly given information of what to expect on our Bigggg day.

Have a look 🙂

The approach to MRCGP CSA assessment:

Each candidate is allocated a consulting room and has 13 consultations, each of 10 minutes, all of which are assessed. Patients are played by Role Players who have been trained and calibrated to perform their role in a consistent manner.

Each of the thirteen cases is marked by a trained examiner using a pre-set marking schedule which is specific to the case. The examiner marks each case on three domains or areas – Data Gathering, Clinical Management and Interpersonal Skills. This creates an overall numerical mark for the case. Each domain carries the same number of marks. The marks for each case are added to create a final mark.

INTERPERSONAL SKILLS: Demonstrating theuseof recognized communication techniques to gain understanding of the patient’s illness experience and develop a shared approach to managing problems. Practicing ethically with respect for equality & diversity issues, in line with the accepted codes of professional conduct.

The grades will be on a four point scale: Clear Pass, Pass, Fail, Clear Fail

Feedback:

Results will be provided in the form of an overall score and a comparative passing score for that day.

Areas of performance which have been identified as deficient by two of more examiners will be flagged according to curriculum area in the candidate’s ePortfolio. This feedback is recorded by the examiner following a specific set of 16 statements as detailed below:

Does not recognize the issues or priorities in the consultation (for example, the patient’s problem, ethical dilemma etc).

Shows poor time management.

Data Gathering

Does not identify abnormal findings or results or fails to recognize their implications.

Does not undertake physical examination competently, or use instruments proficiently.

Clinical management

Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.

Does not develop a management plan (including prescribing and referral) reflecting knowledge of current best practice.

Does not show appropriate use of resources, including aspects of budgetary governance.

Does not make adequate arrangements for follow-up and safety netting.

Does not demonstrate an awareness of management of risk or make the patient aware of relative risks of different options.

Does not attempt to promote good health at opportune times in the consultation.

Interpersonal skills

Does not appear to develop rapport or show awareness of patient’s agenda, health beliefs and preferences.

Poor active listening skills and use of cues. Consulting may appear formulaic (slavishly following a model and/or unresponsive to the patient), and lacks fluency.

Does not identify or use appropriate psychological or social information to place the problem in context.

Does not develop a shared management plan, demonstrating an ability to work in partnership with the patient.

Does not use language and/or explanations that are relevant and understandable to the patient.

These statements can be interpreted by reference to the document ‘Candidate feedback: suggestions for improvement’.

The Cases:

Below is a sample case to illustrate the type of consultation you might expect to have.

Diabetes and depression

Summary of the case presentation:

The patient is a lady with well controlled Type 2 diabetes mellitus. She is presenting with the symptoms of depression. The candidate’s task is to find out why she has presented and obtain the relevant details that enable the following decisions to be made:

What is the main problem here? Is it the diabetes or something else?

If it is something else, could it be low mood in which case is the patient clinically depressed or just fed up?

Having made these decisions, the candidate has to formulate a diagnosis and consider the clinical priorities, involving the patient in developing a shared management plan. All of this has to be done in a patient centered way, obtaining her ideas, concerns and expectations and incorporating these into the explanation given to her.

Why is this type of case being chosen?

This case illustrates the co-morbidity often seen in general practice presentations. The candidate is given the opportunity to demonstrate his/her skill in identifying the constituents at play, prioritising them and dealing with the problem presented in the consultation. In this case, the lady’s diabetes is well controlled and she has no diabetic complications. The candidate simply has to establish this and then move on to diagnosing her presenting ‘problem’. On the face of it, having two conditions in a consultation may seem complicated and challenging, but the task required is much more focused and should be manageable in the 10 minutes allowed for the case.

Further information:

If you need any further information please contact the RCGP Assessment team by telephone on 0203 188 7400 or 0208 253 4350 (during assessment periods only) or by e-mail to exams@rcgp.org.uk.